Low Test Results Post Cycle After 2.5 Months

[Hank14]

I did my first cycle of test and eq. Gained about 15 lbs of muscle. Did post cycle therapy with Clomid and Nolvadex for 4 weeks. Ever since I have felt sluggish depresed and no sex drive. I went to the doc and my test levels were in the gutter. My ball size went back to normal. Its been almost 3 months. I was recommended to a endocrinologist. He tested my levels and they were low too. I told him it has been 6 months since I took a prohormone supplement, didnt say steroids.
Had an MRI no tumor. He gave me androgel. I have been taking it, 2 squirts for a week. I wouldnt say it has put my sex drive completely back to normal but in general I feel better.

Now I am starting to wonder if I didnt wait long enough? Maybe I should wait longer before thinking I am screwed up for life? How long should I wait? I dont know what to do. But this sucks.

 

[Michael Scally MD]

I did my first cycle of test and eq. Gained about 15 lbs of muscle. Did post cycle therapy with Clomid and Nolvadex for 4 weeks. Ever since I have felt sluggish depresed and no sex drive. I went to the doc and my test levels were in the gutter. My ball size went back to normal. Its been almost 3 months. I was recommended to a endocrinologist. He tested my levels and they were low too. I told him it has been 6 months since I took a prohormone supplement, didnt say steroids.
Had an MRI no tumor. He gave me androgel. I have been taking it, 2 squirts for a week. I wouldnt say it has put my sex drive completely back to normal but in general I feel better.

Now I am starting to wonder if I didnt wait long enough? Maybe I should wait longer before thinking I am screwed up for life? How long should I wait? I dont know what to do. But this sucks.

What are the numbers, specifically LH & TT? Starting TRT for AIH is the wrong course of treatment.

 

[Hank14]

I dont have a copy of the numbers but the test score was lower than the low end range. LH was lower than low range.

I am suppose to go in again in a week to see how I am doing. I am embarrassed to now change my story. If i told him the truth is there anything he can give me to increase my LH that would then cause my test to come back?

Maybe I do have low test? I am very confused.

 

[Hank14]

The results from the 1st doc not endo results were
Testosterone Total 49 240 - 950 ng/dL

Testosterone Free 1.4 8 - 30 ng/dL

 

[Michael Scally MD]

The results from the 1st doc not endo results were
Testosterone Total 49 240 - 950 ng/dL

Testosterone Free 1.4 8 - 30 ng/dL

Assuming there is no other cause for the AIH (proper workup), the next step is a hCG challenge test. The doctor should know this, but it is not surprising under the circumstances. In other words, check the testes function. TRT will worsen the problem.

 

[Hank14]

Okay... So basically when I go in next week I need to tell him that I just got off steroids 3 months ago?

Can I keep taking andro gel until then? If I keep taking it will he still be able to give me the function test when I go in?

 

[Michael Scally MD]

Okay... So basically when I go in next week I need to tell him that I just got off steroids 3 months ago?

Can I keep taking andro gel until then? If I keep taking it will he still be able to give me the function test when I go in?

Doctors react quite differently! I have had patients literally ordered to leave the office. More often, the doctor does not understand or know what to do. And far too often placed on TRT. So, what you say is what is best for your care. There are reports of PH causing AIH. As far as the AndroGel, this will depend on the doctor's knowledge.

 

[Michael Scally MD]

Since the purpose is two-fold: (1) check for testes function, and (2) restore testes function, I use 2,000 IU SC Q3D X 10. I check the TT after the 5-6 injection. If the level is satisfactory (350+), I begin SERM treatment as described elsewhere. The use of a single GnRH agonist injection is performed if there is no gonadotropin response. Nothing is written in stone (many variations), but bloodwork is ESSENTIAL.

hCG Stimulation Test

de Kretser DM, Burger HG, Hudson B, Keogh EJ. The HCG stimulation test in men with testicular disorders. Clin Endocrinol (Oxf) 1975;4(6):591-6. The HCG stimulation test in men with testicular di... [Clin Endocrinol (Oxf). 1975] - PubMed result

The rise in plasma testosterone levels following stimulation with human chorionic gonadotrophin (3000 i.u./day for 4 days) has been used as a test of interstitial cell function in normal men and men with testicular disorders. The large majority of patients with testicular disorders resulting in infertility, showed a subnormal testosterone response to stimulation. The most marked impairment was noted in those patients with the biopsy appearance of germinal cell arrest and Sertoli cell only syndrome.


Grant DB, Laurance BM, Atherden SM, Ryness J. HCG stimulation test in children with abnormal sexual development. Arch Dis Child 1976;51(8):596-601. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1546104/pdf/archdisch00826-0034.pdf

Plasma testosterone was estimated by radioimmunoassay in 60 children with disorders of sexual development before and after stimulation with human chorionic gonadotrophin (HCG). In 21 children the testosterone levels after 3 and 5 daily injections of 1000 units HCG were compared and good correlation was found between the paired results (r =0-93), suggesting that the 5-day HCG test has no advantage over the 3-day test. In 7 boys with apparently normal genital development the increments in plasma testosterone ranged from 2-0 to 8-5 nmol/1 after 3 injections of HCG. 10 boys with anorchia showed little response to HCG stimulation, but in patients with other disorders, such as micropenis (10), cryptorchidism (8), hermaphroditism (3), male pseudohermaphroditism (13), hypospadias (3), and sex chromosome anomalies (6), there was considerable variation in the plasma testosterone level after HCG. In 2 boys with suspected anorchia the results suggested that testes were present and this was confirmed at operation.


Yazici M, Sahin M, Bolu E, et al. Prediction of testosterone response to human chorionic gonadotrophin in idiopathic hypogonadotropic hypogonadism patients. J Natl Med Assoc 2009;101(1):71-6. http://www.nmanet.org/images/uploads/Publications/OC71.pdf

[Twenty-five of the men with IHH were tested with hCG (Pregnyl, Organon, Italy). Subjects were given 5000 IU intramuscularly on 3 alternate days.]

In clinical practice, the human chorionic gonadotrophin (hCG) stimulation test is widely used to evaluate testicular function. Inhibin B, a gonadal peptide regulating follice-stimulating hormone (FSH) secretion, is an established marker of Sertoli cell function and spermatogenesis in adults. The aim of this study was to determine whether basal inhibin B levels are able to predict testosterone response to hCG in idiopathic hypogonadotropic hypogonadism (IHH) patients and to evaluate the correlation between inhibin B and gonadotropins in these patients and controls. Inhibin B (n=15) and other hormones (n=29) were measured in 29 patients with IHH and 32 controls. Inhibin B (n=8) and testosterone levels (n=25) before and after hCG stimulation were measured in 25 male patients with IHH by an immunoassay specific for inhibin B. Basal inhibin B was compared to the testosterone increase after hCG. There was a significant increase in inhibin B (22.6 +/- 9.8 vs 45.07 +/- 13 pg/mL; p=.005), free testosterone (2.92 +/- 0.55 vs. 7.9 +/- 1.5 pg/mL; p=.002), and total testosterone (69.0 +/- 15.9 vs. 184.9 +/- 44.1 ng/mL; p = .013) levels 72 hours after hCG injection. Inhibin B and the hCG-induced free testosterone and total testosterone increment correlated strongly (r=0.802, P<.001; r=0.793, P<.001, respectively). We conclude that basal inhibin B predicts the testosterone response to hCG in IHH patients and therefore gives reliable information about Leydig cell reserve. Furthermore, inhibin B levels show negative correlation with luteinizing hormone (LH) in control patients and positive correlation with FSH and LH in IHH patients. LH may effect inhibin B secretion. Further studies are necessary to define the physiology of inhibin B in human males.


Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ. American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update. Endocr Pract 2002;8(6):440-56. https://www.aace.com/sites/default/files/hypogonadism.pdf

[hCG Stimulation Test.—Various protocols are used for hCG stimulation testing. In general for postpubertal male patients, a single dose of hCG (5,000 IU intramuscularly) is administered, and pretherapy and 72-hour posttherapy testosterone measurements are done (some protocols use 1,000 to 4,000 IU of hCG or multiday dosing) (14).]

In these clinical practice guidelines, specific recommendations are made for determining the most effective methods of diagnosing and treating hypogonadism in adult male patients. The target populations for these guidelines include the following: (1) men with primary testicular failure requiring testosterone replacement (hypergonadotropic hypogonadism); (2) male patients with gonadotropin deficiency or dysfunction who may have received testosterone replacement therapy or treatment for infertility (hypogonadotropic hypogonadism); and (3) aging men with symptoms relating to testosterone deficiency who could benefit from testosterone replacement therapy. Initial hormonal evaluation generally consists of a testosterone determination, in conjunction with a free testosterone or sex hormone-binding globulin level, inpatients with clear symptoms and signs but normal-range total testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels. Other possible tests include semen analysis, pituitary imaging studies, genetic studies, bone densitometry, testicular ultrasonography,testicular biopsy, and specialized hormonal dynamic testing. Therapeutic options generally consist of testosterone replacement by injections, patches, or topically applied gel in hypergonadotropic patients and in hypogonadotropic patients not interested in fertility. In hypogonadotropic patients interested in fertility, gonadal stimulation option scan be considered, including human chorionic gonadotropin stimulation therapy with or without human menopausal gonadotropin (or follicle-stimulating hormone) or gonadotropin-releasing hormone pump therapy. These therapies may be combined with assisted reproductive technologies such as in vitro fertilization with intracytoplasmic sperm injection, which may allow pregnancy to occur with very low numbers of sperm.

 

[Hank14]

Doctors react quite differently! I have had patients literally ordered to leave the office. More often, the doctor does not understand or know what to do. And far too often placed on TRT. So, what you say is what is best for your care. There are reports of PH causing AIH. As far as the AndroGel, this will depend on the doctor's knowledge.

In that case I should just explain that the end date of PH use was more recent after I looked it up. And after some research I think we should try the hCG Stimulation Test.

So is this just a test of it functioning normally? Or should this restore normal function?

I told the doc I think this is in response to the pro hormonal supplements. I have elevated RBC count that is at the top of the normal range. He seemed concerned about this. I wonder if he is even going to know what this test you recommend is? Seems like he should have first tried that.

 

[Michael Scally MD]

In that case I should just explain that the end date of PH use was more recent after I looked it up. And after some research I think we should try the hCG Stimulation Test.

So is this just a test of it functioning normally? Or should this restore normal function?

I told the doc I think this is in response to the pro hormonal supplements. I have elevated RBC count that is at the top of the normal range. He seemed concerned about this. I wonder if he is even going to know what this test you recommend is? Seems like he should have first tried that.

It might restore function, but after a successful hCG challenge, one should begin the second half - SERM. The hCG test is described in the AACE link above. I suggest the protocol I posted. Also, the AACE link describes the clomiphene challenge test.

It sounds like you have polycythemia, which is a give away for AAS, not PH. I am doubtful your doctor will catch on.

 

[Hank14]

It might restore function, but after a successful hCG challenge, one should begin the second half - SERM. The hCG test is described in the AACE link above. I suggest the protocol I posted. Also, the AACE link describes the clomiphene challenge test.

It sounds like you have polycythemia, which is a give away for AAS, not PH. I am doubtful your doctor will catch on.

In general how effective is this stimulation test in restoring normal function?

Is it generally more effective after the 2ne half clomiphene?

If a person was on steroids and then stopped cold turkey, would normal function return eventually? How long would it take?

 

[Hank14]

So I had the appointment with the doctor. Waiting to get blood work back to see levels now being on the gel for 2.5 weeks.

I told him about the HCG stimulation test. He seemed to think it would be pointless because after I would get off of it the signal from my brain would still be low? He seemed more worried about checking to see if my semen was good.